The goals of treatment for juvenile rheumatoid arthritis are to reduce swelling, pain and fever and to increase comfort and joint mobility. To be successful, treatment needs to address all aspects of the illness. Medications, including NSAIDs, DMARDs and Corticosteroids (all explained in this website under Medications) are frequently the first line of treatment for JRA. Medical care may be overseen by the child’s primary care provider, with consultation with a pediatric rheumatologist, as well as with other doctors.

Medical treatment is only part of the equation. Your child’s treatment team also may include physical and occupational therapists and a psychologist or counselor. A social worker can help the family cope with the social, financial, and emotional aspects of the disease. While regular, daily exercise is regarded today as equally important as medications in the treatment of JRA (see Exercise section of kidswitharthritis).

Specific medical treatment includes:

• Medication – Because juvenile rheumatoid arthritis occurs among children, dosage amounts should be carefully monitored. Most of these medications reduce pain, swelling and fever, although the time it takes for them to create changes varies from child to child.

• Vision Services – Eye problems such as uveitis (explained under Eye Care) are common among children with specific types of juvenile rheumatoid arthritis. Once JRA is diagnosed, it is very important to have regular eye appointments. Early examination of the eyes helps to prevent further complications and possible blindness.

• Dental Care – Dental care can greatly help children with jaw complications which cause eating and other important movements to be difficult (explained under Dental Care).

• Surgery – While surgery may reduce pain, it is rarely used.

Other treatment options include:

• Healthy Eating – Maintaining a healthy diet is very important, especially among those with juvenile rheumatoid arthritis (explained under Diet/Nutrition). Eating too little (often due to pain in the jaw or feelings of sickness) can cause weight loss and deplete the body’s nutrient levels. Weight gain (often caused by unhealthy eating or medication) strains the joints. Also, it is very important to eat a diet filled with calcium-rich food in order to bring health to the bones.

• Exercise – When juvenile rheumatoid arthritis is present, it is especially important to keep the body strong and flexible (explained under Exercise Tips). Strong muscles help to support the joints of the body. Swimming, walking and bicycling are beneficial to a child with JRA. It is also important to stretch prior to performing any type of exercise. Before starting a new sport, it is necessary to talk with your doctor regarding the safety of the sport.

• Physical and Occupational Therapy – Physical therapy is another important aspect of treating juvenile rheumatoid arthritis. This practice is especially important for children who no longer have overall movement in the joints or for those who have stiff joints. While parents may be reluctant to have their child exercise because of pain associated with movement, a physical therapist can provide guidance for safe levels of exercise to maintain muscle tone and preserve and recover range of motion of the joints. Some children may need specific therapy plans to recover lost range of motion, and to learn how to protect their joints. A physical or occupational therapist may also recommend methods and apparatus to maintain your child’s normal bone growth, such as joint-protection techniques, the use of splints (bracing) and instruction in using large joints, rather than small joints, to carry things.

• Splints and Braces – Many physical therapists will create splints for their clients (explained in this website under Bracing). A splint can be used to move a joint back into its normal position or to prevent severe deformities. Splints are most commonly used on the knees, wrists, and fingers.

Additional treatment options

While the above treatments form the cornerstone of care for juvenile rheumatoid arthritis, there is increasing interest in remedies such as the application of warm and cold packs, and the use of wax baths. Many parents claim that they help to reduce their children’s swelling, pain and fever, even if that reduction is only temporary. Please be advised that some of the following treatments may not be easily available, or that your pediatric rheumatologist may not know about them, or might not believe that they are useful.

Thermotherapy is the term used for heating modalities. These include the heating pad, hot water bottles, paraffin wax baths, and the therapeutic heat wrap. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS; a subsection of NIH) stresses that heat can reduce the pain and inflammation of arthritis by increasing blood flow, maximizing the patient's tolerance for pain, and enhancing flexibility. The agency also points out that heat application does not require a professional physical therapist but may be safely applied at home. The agency suggests that patients place warm towels or hot packs directly over an inflamed joint after taking a warm bath or shower. When using specific heating devices, please read the labels carefully for arthritis-specific information. Consider that the risk of burns rises if the patient sleeps while using a heating pad. On the other hand, the therapeutic heat wrap may be used while sleeping, since it produces safe, low-level heat therapy.

In Hot wax bath therapy, paraffin wax is heated to 50 degrees centigrade in a special container. The child’s joint is then coated by being repeatedly dipped in the hot wax bath, then wrapped in a terry towel to provide insulation, to transfer the energy released from the solidification of the wax to the underlying tissues of the limb.

Cryotherapy is the application of cold to help reduce the pain of arthritis by numbing the nerves surrounding the joint. Cryotherapy reduces the inflammation of arthritis and minimizes muscle spasticity. Home methods of applying cryotherapy include using gel packs or homemade cold packs that contain ice or cold water in flexible bags. However, the patient should be urged to remove the cryotherapy device whenever the area becomes numb or in 20 minutes, whichever comes first. 

Deep microwave hyperthermia is advantageous to patients with JRA because it has the advantage of heating the target organ, while sparing the adjacent tissues. In experiments in Israel, the hyperthermia apparatus consisted of a power source with a cooling system for the skin. When applied to the knees, all patients noted a sensation of warmth in the treated area. After four bi-weekly treatments, patients experienced reduced pain and knee circumference and increased range of motion, for six weeks following the last treatment, with no observable adverse reactions.

A TENS (Transcutaneous (Trans-Q-Tain-E-Us) Electrical Nerve Stimulation unit is a pocket size, portable, battery-operated device that sends electrical impulses to certain parts of the body to block pain signals. The electrical currents produced are mild, but can prevent pain messages from being transmitted to the brain and may raise the level of endorphins (natural pain killers produced by the brain). Electrodes are attached to the surface of the skin over or near the area where you are experiencing pain. TENS units are prescribed for both acute pain and chronic pain conditions such as: arthritis, joint pain and fibromyalgia.

For some chronic pain patients, a TENS unit provides pain relief that can last for several hours. Some patients hook the unit onto a belt turning it on and off as needed. TENS units should only be used under the direction of a doctor or physical therapist.